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Public Health in the Past, Present and Future

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Public Health in the Past, Present and Future th NEPAL PUBLIC HEALTH FOUNDATION LECTURE ON PUBLIC HEALTH IN THE PAST, PRESENT AND FUTURE By Dr. Hemang Dixit June 30, 2013, Kathmandu, Nepal Advisors Kenneth J. Rothman (Boston) Kul Chandra Gautam Mangal Siddhi Manandhar Mathura P.Shrestha Rita Thapa Suniti Acharya Founding Members Aarati Shah Achala Baidhya Alina Maharjan Executive Board Arjun Karki Aruna Upreti Mahesh K. Maskey President Ashok Bhurtyal Bhagwan Koirala Badri Raj Pande Vice President Buddha Basnyat Acting Executive Chair D.S Manandhar Sharad Onta Gajananda P. Bhandari General Secretary I.M. Shrestha Tirtha Rana Karuna Onta Treasurer Nabin Shrestha Narendra Shrestha Nilamber Jha Members Rajani Shah Bharat Pradhan Rajendra BC Binjwala Shrestha Ramesh Kant Adhikari Chhatra Amatya Renu Rajbhandari Daya Laxmi Joshi Sameer Mani Dixit Kedar P Baral Shyam Thapa Lonim Prasai Dixit Suresh Mehata Shanta Lall Mulmi Shiba K. Rai Life Members Shrikrishna Giri Abhinav Vaidhya Archana Amatya Lochana Shrestha Listed alphabetically by first name graphic design Bikram Chandra Majumdar and Bindu Kumar Tandukar th 1 NEPAL PUBLIC HEALTH FOUNDATION LECTURE ON PUBLIC HEALTH IN THE PAST, PRESENT FOUNDATION PUBLIC HEALTH NEPAL AND FUTURE Organized by Maharajgunj, Kathmandu-4 P.O. Box: 11218, Phone: 977-1-4410826, 4412787 Fax : 977-1-4412870 E-mail: [email protected] www.nphfoundation.org FOREWORD Annual Public Health Lecture has been a regular activity of Nepal Public Health Foundation (NPHF) performed on 30 June every year since after inaugural lecture by an eminent public health personality, Mr. Kul Chandra Gautam, Advisor to NPHF and former Under Secretary General of the United Nations and Deputy Executive Director, UNICEF. The topic he chose to speak was on 10+2 Agenda for Public Health in Nepal, which was widely acclaimed. It has paved way to the understanding of modern public health in a critical manner. Organization of the annual public health lecture is a core activity of NPHF inviting eminent personalities with contribution in the field of public health. So far NPHF had the pleasure to organize lecture on 'Understanding Public Health : Conceptual and Philosophical Foundation' by Dr. Mathura Prasad Shrestha, an eminent Public Health Personality and health right activist, former Minister of Health and also advisor to NPHF. It was followed by lecture on Control of Non-Communicable Diseases in Nepal: Scientific, Social and Spiritual Perspectives by Dr. Mrigendra Raj Pandey, eminent cardiologist and first Executive Chairperson of Nepal Health Research Council and a believer in holistic approach to health. These lectures were very rich in content and provided new dimension in thinking of public health. The lecture by Dr. Hemang Dixit is the fourth in the series dwelling on the Present, Past and Future of Public health in Nepal. A Pediatrician by training and educationist, also a prolific writer, Dr Dixit has traced the history of public health much before 4000 B. C. as revealed from excavations at Mohen-Jo-Daro and Harappa in Indian sub-Continent. In Nepal, an Arogyashala (Ayurvedic Hospital) existed during Lichhavi dynasty long before the sixth century A. D. He pointed out that modern medicine was introduced only during 1740 A. D. and the concept of public health and hygiene was put in practice since. The paper has thrown light on the present state of public health and what he thinks should the future be. I would like to express gratitude to Dr Dixit for the paper, packed with information on the state of public health in Nepal. Nevertheless, the views expressed are personal and not the formal position of NPHF. In the end, I would like to thank the NPHF staff, in particular Ms. Ashmita Chaulagain and Ms. Shila Bhandari for working hard in its publication. Dr. Badri Raj Pande Acting Executive Chair KEYNOTE ADDRESS Public health in the past, present & future Dr. Hemang Dixit It has been postulated that life originated 600 million years ago and that the continental drift, creating the five continents, occurred some 200 million years ago. Mammals have been estimated to have evolved some 140 million years ago. Hominids i.e. the human type evolved 20 million years ago. However modern man only came on the scene some 200,000 years ago. His migration and colonization of the world occurred during the course of the last 50,000 years. The spoken language developed during the course of the last 10,000 years whilst writing came into being only a few thousand years ago. The phenomenal progress that took place was only over the course of 5000 to 10,000 during the life span of just 200 to 400 generations. - From Dr. Abdul Kalam’s website: www.abdulkalam.com (1) 03 When we consider the existence of the universe we realize that what we are talking about is an insignificant period of time in the history of the Universe. Besides us humans the range and varieties of lives are immense but because of the callousness of humans many of the flora and fauna have disappeared or have become endangered species. What should be the duty of us humans is that we should leave the earth in the same or in a similar condition that we found it in. This is becoming difficult if not nearly impossible because of various factors that have come into or are coming into our lives. Range of health conditions facing any population varies in the different parts of the world. The definitions of this term have varied from time to time but two which were made in 1988 may be quoted here. 1. Public Health is the science and art of preventing disease, prolonging life FOUNDATION PUBLIC HEALTH NEPAL and promoting health through the organized efforts of society. Acheson report -1988 2. Public Health is what we, as a society, do collectively to assure the conditions for people to be healthy. This requires that continuing and emerging threats to the health of the public be successfully countered ……. Through effective, organized and sustained efforts led by the public sector. The Institute of Medicine -1988 This second quote is in the Introduction to the Oxford Textbook of Public Health (2). PAST Excavations at Mohen-Jo-Daro in Sind and Harappa in the former India, threw light on the Indus Valley civilization and suggested that the people living there as early as in the fourth millennium BC had a high level of public health facilities. The Greeks too had in the BC period, their medical practices with Aesculapius’ Temple of Healing. The Romans in the first millennium too had Public Health facilities in the form of Baths, Drainage canals etc. Pompeii, a city founded in BC and near Naples in Italy had baths, a good water supply and a drainage system. It was buried by the volcanic ash in 79 AD. An unidentified epidemic, Plague struck Athens in 430 BC. Leprosy is mentioned in the Bible. In olden days diseases were said to be a form of punishment from the Gods. This thought was prevalent in Europe especially with regard to Leprosy and Plague The methods to deal with it were segregation and fumigation. Because of the impending shortage of water, running water flushes and drainage systems is a thing of the past. The Romans had it, and then the British who as colonial masters could do it and finally the Americans because they had funds and could afford it. Now it is a becoming a thing of the past. Plague – Black Death (1347-53) caused rampant havoc in Europe. The European population of the 14th Century was then reduced by one third as a result of this. Following this epidemic, plague recurred every two decades for the next three centuries. In 1830 cholera as a disease arrived in Europe and the poor were mainly affected. Even in what are now developed countries, the conditions of living for the average man or woman in the 18th and 19th Centuries was very unsatisfactory. Health problems were under-nutrition, respiratory diseases as a result of the crowed living or the working conditions in the industries and diarrhoeal diseases because of faecal contamination of drinking water. The story of the Broad Street Pump, the cholera outbreak of 1854 in London, its investigation and solving of the problem by John Snow is well known. It is said that charges were laid by the poor on the rich who they blamed for propagating the disease to kill off the poor. One reason given by the poor was that dead bodies were required for the training of doctors and so this move. Other major diseases of Public Health importance were: • Venereal Disease (STD) – French pox. Liaisons with Italian sex workers. • Smallpox • Others e.g. Typhus, Typhoid etc. It is accepted in Judeo-Christian and Islamic nations that there are many commandments or suggestion in all the Holy Scriptures about the acceptable conduct of human beings. Similar thoughts are expressed in our Buddhist and Hindu scriptures (3) PRESENT Day of modern medicine may be said to have started from the time of World War II. Though Penicillin was discovered by Fleming in 1928 it was produced and then used extensively during the war years and after that. Older vaccines then in use were for Smallpox, TB and later poliomyelitis. Changes in thought – Britain introduced the concept of the National Health Service (NHS) at the time of Attlee Labour government when Aneurin Bevan was the Health Minister. This was the first time that such an enterprise on 05 such a scale was being put into practice. The Americans also considered this type of service for themselves but did not start it for they felt that it would be expensive. It has been shown in Britain and Japan in the post war years that good health of the population increases social productivity.
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